Diagnosis and Treatment of Male Infertility

According to the World Health Organization’s definition, Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Studies have shown that 15% of couples experience this problem. Infertility can be due to factors affecting women, men, or both.

When couples who could not have children were investigated, 40% of infertility cases were found to be caused by men, 40% were caused by women, 10% by both, and 10% due to unknown reasons.

The diagnosis and treatment of male infertility are carried out by urology and andrology specialists. Today, the reason for infertility can be identified easily thanks to various monitoring techniques and tests. The infertility problem can be treated after preparing a special plan for the patient. 

What is Male Infertility?

Men start to produce sperm in adolescence and continue to produce sperm throughout their lives. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) secreted from the hypophysis gland in the brain cause sperm to mature.

The sperm produced in the testicles and matured in the epididymis is ejaculated into the vagina during sexual intercourse. The sperm is produced in approximately 40-70 days. Any problems in the production, maturation, and ejaculation stages might be the reason for male infertility, which includes the following:

• Varicocele,
• Sperm production disorders,
• Sperm channel obstruction,
• Testicular trauma,
• Hormonal disorders,
• Anatomic problems,
• Genetic diseases,
• Infection,
• Certain medications.

This might have psychological and psychological implications resulting from a sense of being inadequate and unhappiness. In this process, support between couples is important. Today, up to 90% of infertility cases can be treated, and there are numerous treatment options. Men who experience infertility can seek help from a doctor and overcome this problem.

What are the Reasons for Male Infertility?

• Varicocele: This is the dilatation of the testicular veins. Varicocele is the most common reason for male infertility, and this causes increased testicular temperature and low sperm motility.
• Ejaculation problems: The semen that is supposed to be ejaculated from the penis might go back to the bladder due to the prostate surgeries, diabetes, urinary tract surgeries, and certain medications. Retrograde ejaculation might be one of the reasons for male infertility.
• Infections: Certain infections (gonorrhea, chlamydia, prostate inflammation, etc.) that impact sperm production and quality might obstruct sperm channels and cause problems.
• Anti-sperm antibodies: Immune cells and antibodies attacking the sperm might try to destroy the sperm cells as foreign cells.
• Undescended testicle: An undescended testicle, which is a fatal developmental disorder, might decrease testicle production.
• Tumor: Tumors that impact sperm production might put reproduction at risk due to medication use.
• Hormonal disorders: Problems in the pituitary, testis, hypothalamus, adrenal glands, and thyroid glands might damage sperm production.
• Tube defects: Damage to sperm tubes due to a disease or trauma might cause male infertility. These tubes might have been damaged from birth.
• Psychological and environmental factors: Various factors, such as sexual problems, medication, industrial chemicals, heavy metal exposure, radiation, alcohol, smoking, sedentary lifestyle, obesity, and long-term bicycle use, might cause male infertility.

What are the Symptoms of Male Infertility?

The most visible symptom of male infertility is not having a child after 12 months, despite having regular and unprotected sexual intercourse. Other than that, it is not possible to talk about a visible symptom. However, some conditions might be indicators of male infertility. These symptoms can be listed as follows:

• Sexual dysfunction (erectile dysfunction, ejaculation problems, etc.),
• Swelling and pain around the sexual organ,
• Swelling around the testicles,
• Discharge from the penis,
• Decreased body hair (indicates hormonal imbalance),
• Low sperm count,
• Problems with micturation.

How is Infertility Diagnosed?

Diagnosis is the most important part of infertility treatments. Couples who cannot have children must undergo an important and long treatment process. Identifying the problem before treatment will prevent financial and immaterial losses for the couple.

Therefore, the infertility diagnosis method must be designed and applied by a surgeon who understands the specific needs of individuals. The diagnosis methods are as follows:

Detailed Medical History and Physical Examination: The medical history of the couple is recorded. The frequency of sexual intercourse, any chronic diseases, surgeries, and sexual health are collected, and physical examinations are carried out. The male is tested first, since the infertility treatment process is more complicated for women.

The testicles and penis are examined in detail in the physical examination. Detailed information about varicocele, abnormalities such as hypospadias/epispadias, testicular volume, penis size, and hearing are collected. A detailed physical examination regarding the diagnosis of infertile males will give important tips to the doctor.

What is a Male Infertility Test?

Spermiogram (semen analysis): The first test of male infertility is a spermiogram. This test is known as the sperm count test and investigates the semen of a man who has not had sexual intercourse for 3 days. Spermiograms must be done by an experienced team based on the criteria identified by the World Health Organization.

Spermiograms must be repeated at 2–3-week intervals to be certain about the diagnosis. The results will give an idea about the sperm count, sperm motility, sperm morphology, and viability. Spermiograms have an important place both in infertility diagnosis and in responses to treatment.

What is a Low Sperm Count and What is the Reason?

A low sperm count indicates impaired sperm parameters. In male infertility diagnoses, sperm parameters are almost always damaged. Sperm count, sperm motility, shape, and liveliness are among the most important sperm parameters. The factors that trigger a low sperm count are as follows:

• Varicocele,
• Physiological anomalies,
• Autoimmune diseases,
• Gluten intolerance (celiac disease),
• Hormonal disorders,
• Cancer treatments,
• Smoking and alcohol use,
• Obesity,
• High temperature,
• Environmental toxins.

What are Other Male Infertility Tests?

Additional tests may be required after the initial tests for the correct diagnosis and treatment. These are as follows:

• Scrotal ultrasound,
• Testicle biopsy,
• Transrectal ultrasound,
• Hormone tests,
• Post-ejaculation urine tests,
• Genetic tests,
• Special sperm function tests.

Male Infertility Treatments

Male infertility treatments are planned after a diagnosis is made and according to infertility reasons, and sperm count in the semen is the most significant target of treatment. If male infertility is due to an underlying disease or structural disorder, these problems must be treated first. The treatments for male infertility are as follows:

• Medication is prescribed if male infertility is due to hormonal imbalances. As such, medication can balance hormone production. The treatment might take up to 2 years in certain cases.
• Subcutaneous Injections are an alternative method applied to patients who can be treated with medication. This treatment will help treat hormonal disorders. The treatment can take 1–2 years.
• Insemination treatment is applied if the sperm count in the semen is above 10 million and if there are no severe sperm defects. This insemination treatment is about washing the collected sperm to clean the dead cells and toxic waste. The sperm is then injected into the uterus with a special catheter so that it can reach the ovary. For this method, there must be mobile sperm, no obstruction in the woman, and normal over quality.
• Assisted reproductive techniques include in vitro fertilization (IVF),intracytoplasmic sperm injection (ICSI),microTESE, and intracytoplasmic morphologically selected sperm injection (IMSI) which are among the methods for promoting male infertility.

How is Male Infertility Treatment Applied?

The first stage of male infertility treatment consists of simple and stimulating elements. The purpose is to eliminate problems with medication treatments, tube obstructions, varicocele surgery (microsurgical varicocelectomy) and hormone treatments. In addition, methods to increase sperm count and quality are applied.

There are lifestyle changes from eating to exercising that can increase the chances of men with infertility becoming fathers. Of these efforts to treat male infertility, I will not yield any results, and assisted reproductive techniques will be used.

The insemination method might be considered if pregnancy does not occur naturally. For more severe male infertility, the final option is microinjection (IVF). The success rate is 30% for insemination, and this success rate increases to 60% with microinjection.

The success of the treatment depends on sperm quality and count, ovary follicle number in a woman, a woman’s uterus, age, medication, and experiences with the specialists. Every couple has a different success rate, but it is possible to achieve pregnancy, even in desperate cases, with treatments applied today.